<div id="innerLoading" align="center">
	<img src="{$base_uri}/images/ajax-loader.gif"/>
</div>
<div id="ticket_demographic" class="form_container">
	<table cellspacing="0" cellpadding="0" style="width: 100%">	
		<tr>
			<td class="label" style='width: 120px; text-align: right'>{translate}Service ticket{/translate}</td>
			<td class="field" id="closed_ticket_name"></td>
			<td class="label" style='width: 120px; text-align: right'>{translate}Day{/translate}</td>
			<td class="field" id="ticket_date"></td>
			<td class="label" style='width: 120px; text-align: right'>{translate}Medicial insurance{/translate}</td>
			<td class="field" id="closed_insurance"></td>
		</tr>		
		<tr>
			<td class="label" style='text-align: right'>{translate}Examination type{/translate}</td>
			<td class="field" id="closed_examination_type"></td>
			<td class="label" style='text-align: right'>{translate}Promotion code{/translate}</td>
			<td class="field" colspan="3" id="closed_discount_program"></td>	
		</tr>
	</table>
</div>
<div class="separator"></div>	
<div id="content_closed_ticket_item">
	<table id="closed_ticket_item" cellspacing="0" cellpadding="0" class="grid" width="100%">
		<thead>
			<tr>
				<th style='width: 30px;'>{translate}Order number{/translate}</th>
				<th>{translate}Service{/translate}</th>
				<th style='width: 120px;'>{translate}Room{/translate}</th>
				<th style='width: 120px;'>{translate}Price{/translate}</th>
				<th style='width: 120px;'>{translate}Discount{/translate}</th>
				<th style='width: 120px;'>{translate}Patient payment_1{/translate}</th>
			</tr>
		</thead>
		<tbody>
			<tr class="payment">								
				<td colspan="2" align="left" style="color: red; font-size: small;font-style: italic; ">{translate}Total{/translate}</td>
				<td colspan="2" align="right" class="last" id="total_amount" style="color: red; font-size: medium;"></td>				
				<td colspan="2">&nbsp;</td>																	
			</tr>
			<tr class="payment">
				<td colspan="2" align="left" style="color: blue; font-style: italic; font-size: small;">{translate}Discount{/translate}</td>
				<td colspan="2" align="right"  class="last" id="discount_amount" style="color: blue; font-size: medium;"></td>
				<td colspan="2" style="font-style: italic">{translate}Discount family condition, examination type and promotion program{/translate}</td>
			</tr>
			<tr class="payment">
				<td colspan="2" align="left" style="color: red; font-size: small;font-style: italic; ">{translate}Patient pays a sum{/translate}</td>
				<td colspan="2" align="right" class="last" id="patient_amount" style="color: red; font-size: medium;"></td>
				<td colspan="2">&nbsp;</td>				
			</tr>
			<tr class="payment">
				<td colspan="2" align="left" style="color: red; font-size: small;font-style: italic; ">{translate}Real payment{/translate}</td>
				<td colspan="2" align="right" class="last" id="real_amount" style="color: red; font-size: medium;"></td>
				<td colspan="5">&nbsp;</td>				
			</tr>										
		</tbody>
	</table>				
</div>	

<div id="modified_payment" style="margin-top:10px; font-style: italic; width: 548px; text-align: right; display: none;">		
	{translate}Change fee{/translate}: <span style="font-weight: bold;text-transform: uppercase; color: red; margin: 5px"></span>   
</div>